Effect of early intervention on 5-year outcome in non-affective psychosis

Institute of Psychiatry, Kings Health Partners, London, UK.
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.99). 05/2010; 196(5):372-6. DOI: 10.1192/bjp.bp.109.066050
Source: PubMed


Early specialised care may improve short-term outcome in first-episode non-affective psychosis, but it is unclear if these benefits endure.
To assess the long-term effect of early intervention in psychosis.
Individuals with first-episode psychosis were randomised to specialised care or care as usual (trial number: ISRCTN73679874). Outcome after 5 years was assessed by case-note review.
There were no significant differences in the admission rate (coefficient 0.096, 95% CI -0.550 to 0.742, P = 0.770) or the mean number of bed days (coefficient 6.344, 95% CI -46 to 58.7, P = 0.810).
These findings that specialist intervention did not markedly improved outcome at 5 years accord with those from a larger OPUS study. The sample size of this study was small and these results should be generalised with caution. More research is needed.

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    • "Many of these have already reported on short-(1–2 years) to medium-(5 years) term outcomes (e.g. Craig et al. 2004; Larsen et al. 2006, 2011; Malla et al. 2008; Gafoor et al. 2010; Nordentoft et al. 2010; Norman et al. 2012). However, only a few have reported longer-term outcomes (e.g. "
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    ABSTRACT: Background: Studies of the long-term course and outcome of psychoses tend to focus on cohorts of prevalent cases. Such studies bias samples towards those with poor outcomes, which may distort our understanding of prognosis. Long-term follow-up studies of epidemiologically robust first-episode samples are rare. Method: AESOP-10 is a 10-year follow-up study of 557 individuals with a first episode of psychosis initially identified in two areas in the UK (South East London and Nottingham). Detailed information was collated on course and outcome in three domains (clinical, social and service use) from case records, informants and follow-up interviews. Results: At follow-up, of 532 incident cases identified, at baseline 37 (7%) had died, 29 (6%) had emigrated and eight (2%) were excluded. Of the remaining 458, 412 (90%) were traced and some information on follow-up was collated for 387 (85%). Most cases (265, 77%) experienced at least one period of sustained remission; at follow-up, 141 (46%) had been symptom free for at least 2 years. A majority (208, 72%) of cases had been employed for less than 25% of the follow-up period. The median number of hospital admissions, including at first presentation, was 2 [interquartile range (IQR) 1-4]; a majority (299, 88%) were admitted a least once and a minority (21, 6%) had 10 or more admissions. Overall, outcomes were worse for those with a non-affective diagnosis, for men and for those from South East London. Conclusions: Sustained periods of symptom remission are usual following first presentation to mental health services for psychosis, including for those with a non-affective disorder; almost half recover.
    Full-text · Article · Feb 2014 · Psychological Medicine
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    • "Patients receiving specialized care reported a greater average number of significant others in their social network (2.40 ± 1.20 vs. 1.71 ± 1.06), which linear regression analysis correlated with significant improvement in total PANNS and GAF (β = 2.95, SE = 1.04), showing the importance of social network in clinical improvement (12). Nevertheless, the intervention did not maintain results after 5-years follow-up in the re-hospitalization rates or in the average number of days/bed (13). There were also no significant differences in cost when compared to ST (14). "
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    ABSTRACT: Background: In Chile, the clinical guidelines “For the Treatment of People from First Episode of Schizophrenia” aim to support individuals with schizophrenia to live independently, establishment occupational goals, and gain an adequate quality of life and social interaction. This requires the implementation of a treatment model that integrates psychosocial and pharmacological dimensions. Community intervention strategies ensure the achievement of these goals. Objectives: This study compiles and synthesizes available scientific evidence from the last 14 years on the effectiveness of community intervention strategies for schizophrenia and related psychotic disorders. Methodology: An electronic search was carried out using PUBMED, LILACS and Science-Direct as databases. Criteria of inclusion: i: randomized clinical trials, ii. Community-based interventions, iii. diagnosis of schizophrenia or related psychotic disorder (section F2 of ICD-10). Exclusion Criteria: i. treatments exclusively pharmacological, ii. Interventions carried out in inpatient settings, ii. bipolar affective disorder or substance-induced psychosis (greater than 50% of sample). Results: 66 articles were reviewed. Community strategies for integrated treatment from the first outbreak of schizophrenia significantly reduced negative and psychotic symptoms, days of hospitalization, and comorbidity with substance abuse and improved global functioning and adherence to treatment. In other stages, there were improved outcomes in negative and positive symptoms and general psychopathology. Psychoeducation for patients and families reduced the levels of self-stigma and domestic abuse, as well as improved knowledge of the disease and treatment adherence. Training focused on cognitive, social, and labor skills has been shown to improve yields in social functioning and employment status. Conclusions: Community-based intervention strategies are widely supported in the treatment of patients with schizophrenia.
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    • "The findings are in line with other recent studies on 3–5 year outcomes reporting that time-limited early specialized interventions for schizophrenia do not improve outcome over time [10,11]. "
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    ABSTRACT: The aim of this study is to compare the 12-year follow-up effects on in- and outpatient services of 2 years of integrated treatment for recent-onset schizophrenia versus treatment as usual in a randomized controlled trial. 50 patients aged 18--35 years were randomized to Integrated Treatment (IT) (N = 30) or Treatment-as-Usual (TAU) (N = 20) for two years. TAU comprised optimal pharmacotherapy and outreach assertive treatment, while IT also included cognitive-behavioural family treatment, skills training, strategies for residual psychotic and non-psychotic problems and home-based crisis management. There were no differences in number of days in hospital, time to readmission, number of admittances to psychiatric wards, number of involuntarily psychiatric admissions or number of outpatient contacts over a period of 12 years following the initial 2-year treatment trial. Fewer patients in the IT group were, however, involuntary admitted to hospital in the period. The intensive two-year psychosocial intervention seemed to have little long-term effects on use of in- and outpatient services.Trial registration: Current Controlled Trials: NCT00184509.
    Full-text · Article · Jul 2013 · BMC Psychiatry
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